The neurophenomenology of early psychosis: An integrative empirical study

Nelson, Barnaby; Lavoie, Suzie; Gawęda, Łukasz; Li, E.; Sass, Louis A.; Koren, Danny; McGorry, Patrick D.; Jack, Bradley N.; Parnas, Josef; Polari, Andrea; Allott, Kelly; Hartmann, Jessica A.; Whitford, Thomas J.

doi:10.1016/j.concog.2019.102845

Cited by 61 publications

(55 citation statements)

References 104 publications

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“…However, deeper disorganized mental states ( e.g ., fragmentation) can be better understood as a result of primary and structural disorder of the “basic” self, rather than an outcome of psychotic defense mechanisms. Psychodynamic taxonomy of psychotic defense mechanisms, as well as clinical descriptions of self-disorders formulated by eminent psychoanalytic scholars ( e.g ., Bion 1959 , 1967 ; Klein, 1946 ), may benefit from future integration with recent developments of neuroscience, philosophy of mind, and phenomenology ( e.g ., Gallagher & Zahavi, 2012 ; Nelson et al, 2020 ; Sas et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Defense mechanisms in adolescents at high risk of developing psychosis: An empirical investigation

Boldrini

Buglio

Giovanardi

et al. 2020

ResPsy

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Research within psychotherapy and psychopathology frameworks has been inspired by the central concept of defense mechanisms, which play a pivotal role in psychoanalysis. Defense specificities have only recently been studied systematically in the context of several clinical diagnoses. The present study aimed to explore the specificities of defense mechanisms in adolescents at ultra-high risk of developing psychosis and test the relationship between defensive functioning and attenuated psychotic symptoms. Twenty-six adolescent inpatients at ultra-high risk of developing psychosis and a matched clinical control group of inpatients not at risk of psychosis were interviewed. Two observer-rater methods, the Defense Mechanism Rating Scales and the Psychotic-Defense Mechanism Rating Scales were applied to interview transcripts to assess the individual use of defenses. Ultra-high-risk patients demonstrated lower defense mechanisms (i.e., total instances of defense mechanisms observed) and lower overall adaptiveness of the defenses presented. When specific differences between groups were observed, psychotic defenses were the sole defenses that could partially discriminate between ultra-high-risk and not at-risk patients. Regarding the relationship between defense mechanisms and subthreshold psychotic symptoms, psychotic defenses were associated with negative and disorganization symptoms, rather than with positive symptoms. The psychological vulnerability of ultra-high-risk patients is discussed and treatment implications for psychotherapy with such challenging patients are addressed.

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Section: Discussionmentioning

confidence: 99%

Defense mechanisms in adolescents at high risk of developing psychosis: An empirical investigation

Boldrini

Buglio

Giovanardi

et al. 2020

ResPsy

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“…However, much of this research has been received as something entirely separate, if not incompatible, with their neuroscientific counterparts. In this article we aim to offer further arguments for such an integration, building upon the efforts by a handful of phenomenologically-minded contemporary clinical researchers [10][11][12][13]16,22 . Moreover, we provide the framework, hitherto not undertaken as far as we can document, to support the novel effort of integrating the original contributions from the Early Heidelberg School concerning the self-disturbances in schizophrenia (neglected until recently) with the later ipseity and neurocomputational approaches.…”

Section: Makingmentioning

confidence: 99%

Thinking, believing, and hallucinating self in schizophrenia

Humpston

Broome

2020

The Lancet Psychiatry

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In this Personal View, we discuss the history and concepts of self-disturbance in relation to the pathophysiology and subjective experience of schizophrenia in terms of three approaches: 1. The perceptual anomalies approach of the Early Heidelberg School of Psychiatry; 2. The more recent ipseity model; and 3. The predictive coding framework. Despite their importance, there has been a notable absence of efforts to compare them and to consider how they might be integrated. The position represented in the current contribution is novel in that it compares the three approaches and offers suggestions how the three may work together. We view selfdisturbances as transformations of self that form the inseparable background against which psychotic symptoms emerge. Integrating computational psychiatric approaches with those employed by phenomenologists in the first two approaches listed above, we argue that delusions and hallucinations are inferences produced under 'extraordinary' conditions and are both statistically and experientially as real for patients as other mental events. Such inferences still approximate Bayes-optimality given the circumstances and may be the only ones available to minimise prediction error. The added contribution we hope to make focuses on how the dialogue between neuroscience and phenomenology may improve clinical practice. We hope this article will act as a timely primer and bridging point for both computational psychiatry and phenomenological psychopathology in its different approaches for interested clinicians. independently predict recovery in psychotic disorders: A seven year follow-up study. Schizophrenia Research 2019; in press.

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“…Thus, the two constructs are close, but refer to different cognitive processes [36]. IRs probably represent self-disturbance [22], proposed as being essential to characterizing psychosis in general and schizophrenia in particular [19]. It is therefore possible that IRs first appear as a reaction, a defensive element more typical of social cognition, and it later becomes more disorganized, as with the participation of dissociation, the stimulating salience increases [44,45].…”

Section: Discussionmentioning

confidence: 99%

“…Summarizing, and taking the presence of interpersonal violence as a starting point, this study poses the possibility that this set of situations favors the appearance of a more automatic defensive cognitive process such as IR, as an expression of self-disturbances [19,24]. At the same time, such violence could activate memories of the relationship with one's parents, causing submission, devaluation, or defense for coping with the threat [12].…”

Section: Introductionmentioning

confidence: 98%

“…Other proposed mediating processes between traumatic events (related to violence) and psychotic symptoms have to do with beliefs about the self and cognitive functioning in the social world [16]. In fact, a major position was given to alterations of the self in understanding the development of schizophrenia in clinical samples, participants in high-risk mental states, and the general population [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Interpersonal Violence and Psychotic-Like Experiences: The Mediation of Ideas of Reference, Childhood Memories, and Dissociation

Fernández-León

Rodríguez‐Testal

Gutiérrez-López

et al. 2020

IJERPH

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Previous studies have demonstrated the relationship between the accumulation of situations involving interpersonal violence (IV) and psychotic-like experiences. This study explored whether IV is related to aberrant salience (AS), using a sequential mediation model that included memories of relationship with parents (submission, devaluation, and threat; Early Life Experiences Scale (ELES)), ideas of reference (IR), and dissociative symptoms (absorption and depersonalization), and whether the patient/nonpatient condition moderated this effect. The sample was made of 401 participants (including 43 patients with psychotic disorders) aged 18 to 71 years (Mage = 30.43; SD = 11.19). Analysis of a serial multiple mediator model revealed that IR, ELES, absorption, and depersonalization fully mediated the effect of IV on AS, explaining 39% of the variance, regardless of the patient/nonpatient condition. The indirect paths, which place IR and dissociation (especially absorption, the variable to which the IR and ELES lead) in a primordial position for being related to AS, are discussed. This continuum model could be useful for understanding processes related to the onset of psychosis unmoderated by the patient/nonpatient condition.

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The neurophenomenology of early psychosis: An integrative empirical study

Cited by 61 publications

References 104 publications

Defense mechanisms in adolescents at high risk of developing psychosis: An empirical investigation

Defense mechanisms in adolescents at high risk of developing psychosis: An empirical investigation

Thinking, believing, and hallucinating self in schizophrenia

Interpersonal Violence and Psychotic-Like Experiences: The Mediation of Ideas of Reference, Childhood Memories, and Dissociation

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